Ericsson C D, Patterson T F, Dupont H L
Am J Med Sci. 1987 Aug;294(2):91-6. doi: 10.1097/00000441-198708000-00006.
To better define the role of antimicrobial therapy among U.S. travelers in Mexico, clinical and nonculture laboratory parameters were compared for 56 patients with shigellosis and 204 others with diarrhea of other causes. The presence of fever, stool mucus and blood, and fecal leukocytes were significantly more common among patients with shigellosis (p less than 0.001) who also tended not to present with mild diarrhea (p less than 0.05). However, clinical and laboratory parameters were either too insensitive or too nonspecific to be useful in identifying most cases of shigellosis or in excluding the likelihood of its presence. Patients with mild clinical presentations, regardless of etiology, experienced resolution of disease sooner than those with moderate to severe presentations (p less than 0.01), but withholding therapy from patients with mild presentations resulted in 48% of these patients remaining ill at the end of 48 hours. Based on these findings, the authors advise empiric use of antimicrobial agents in travelers with diarrhea associated with fever, bloody stools, or fecal leukocytes, and for all travelers with moderate and severe diarrhea. If therapy is withheld from patients with initially mild presentations, a proportion might still require therapy, possibly an antimicrobial agent, for optimal control of symptoms.
为了更好地界定抗菌治疗在美国赴墨西哥旅行者中的作用，对56例志贺菌病患者和204例其他原因腹泻患者的临床及非培养实验室参数进行了比较。发热、粪便黏液和血液以及粪便白细胞在志贺菌病患者中更为常见（p<0.001），且这些患者往往没有轻度腹泻（p<0.05）。然而，临床和实验室参数要么过于不敏感，要么过于非特异性，无法用于识别大多数志贺菌病病例或排除其存在的可能性。无论病因如何，轻度临床表现的患者比中度至重度临床表现的患者疾病缓解得更快（p<0.01），但对轻度临床表现的患者不进行治疗会导致48%的此类患者在48小时结束时仍未痊愈。基于这些发现，作者建议对伴有发热、便血或粪便白细胞的腹泻旅行者以及所有中度和重度腹泻的旅行者经验性使用抗菌药物。如果对最初轻度临床表现的患者不进行治疗，一部分患者可能仍需要治疗，可能是使用抗菌药物，以实现症状的最佳控制。
